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General NPI Number Information
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NPI Number | 1689023467
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Entity Type | Organization
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Legal Business Name | ASMIK MADOULIAN DDS INC
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 10903 MAGNOLIA BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-3904
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Country | US
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Telephone | 818-762-9112
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Fax | 818-762-4974
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Provider Business Mailing Address
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Address Line | 10903 MAGNOLIA BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-3904
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Country | US
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Telephone | 818-762-9112
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Fax | 818-762-4974
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ASMIK ANDRANIK MADOULIAN
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Credential | DDS
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Telephone | 818-762-9112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 45287
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License Number State | CA
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